Meningitis – The LP

An LP should be performed unless there are signs of increased ICP, such as:

1.Reduced or fluctuating GCS

2.Relative bradycardia and hypertension

3.Focal neurological signs or abnormal posturing

4.Unequal or unreactive pupils

5.Papilloaedema

-Or if the patient is shocked, post seizure without control, purpura or coagulopathy.

NB Clinical signs of increased ICP should suffice and a CT is not usually indicated.

LPs are not always easy to obtain, especially in the older child and adults, with ultrasound guidance being an evolving technique [1]

-DO NOT DELAY THE ADMINISTRATION OF ANTIBIOTICS IN AN UNWELL CHILD WHILE WAITING TO PERFORM AN LP.

-PCR is a useful technique for detecting bacterial pathogens, it allows for detection of small strands of DNA, from bacteria that may have been lysed or damaged by antibiotics or transportation to the laboratory.